Replacement

As I was looking at my patient laying in bed after her abdominal surgery, I remembered that she has smoked about two-packs a day since the late 60's. She's been smoking longer than I've been alive. This explained her poor oxygenation and terrible wheezing.

All of the immediate health risks aside, I was sure she was dying for a cigarette. The last thing I need is a patient to become irritable and demanding from nicotine withdrawal. It drives the nurses crazy. Then the nurses call me to complain, and that drives me crazy. So I thought I'd intervene early.

I always ask if they honestly want to quit, and help them if they're willing. If they reply with anything less than an enthusiastic response, I leave them be and let their primary care physicians deal with it. I've long given up any hope of convincing people to quit smoking. I'd have better success trying to get someone to fall for that Nigerian money scam.

Unless they're willing, trying to force someone to quit smoking is about as easy as trying to force someone to change their political views. It just isn't going to happen. So instead, I just try to decrease their nicotine cravings by pasting on nicotine patches like how a 3rd-grader would decorate his notebook with stickers.

Happy patient = happy nurse = less annoying phone calls to me. And then I can spend my time doing something more important. Like blogging.

Me: I know you're a pretty heavy smoker, and it's now been two days since your last cigarette... would you like for me to prescribe you a nicotine patch to tide you over?

Patient: No. I'm OK for now.

[She did look quite comfortable. I began to wonder if she's somehow been sneaking out for smokes.]

Family member: Yeah, she'll be OK, Doctor. She always quits when she's admitted to the hospital.

Me: [in pleasantly surprised disbelief] You're gonna try to quit?

Patient: No, of course not, don't be silly! Once I get out, I just smoke double what I've been doing in order to catch up.